From the Guidelines
Women with PCOS and amenorrhea can achieve pregnancy through a combination of weight control, regular exercise, and medication.
Treatment Options
- Clomiphene citrate is the recommended initial medication for ovulation induction, with an 80% ovulation rate and a 50% conception rate in women with PCOS 1.
- If clomiphene treatment fails, low-dose gonadotropin therapy may be used to induce ovulation, with a high rate of monofollicular development and a lower risk of ovarian hyperstimulation 1.
- Insulin-sensitizing agents, such as metformin, may also improve ovulation rates, although their effects on early pregnancy are not well established 1.
- GLP-1 RAs, such as exenatide, liraglutide, and semaglutide, have shown variable weight reduction efficacy and metabolic and reproductive benefits in PCOS, but evidence on fertility outcomes is limited 1.
Lifestyle Modifications
- Weight loss, even as little as 5% of initial weight, can improve metabolic and reproductive abnormalities in PCOS, including ovulation and pregnancy rates 1.
- Exercise may also have positive effects on PCOS, even without weight loss, although data is limited 1.
From the Research
Treatment Options for Women with PCOS and Amenorrhea
To achieve pregnancy, women with PCOS and amenorrhea can consider the following treatment options:
- Lifestyle modification, including dietary changes and weight loss, as first-line intervention for overweight or obese women with PCOS 2, 3
- Medications such as metformin to improve ovulation rates for women who cannot take combined hormone contraception or are attempting conception 2
- Ovulation induction techniques, including letrozole and clomiphene, with letrozole being superior to clomiphene 4
- Insulin sensitizing agents to treat insulin resistance 3
- Assisted reproductive techniques (ART) as an alternative for anovulatory patients 3, 5
Fertility Management
For women with PCOS and amenorrhea, fertility management may involve:
- Ovulation induction as first-line management of infertility 4
- Gonadotrophins as second-line treatment for women resistant to clomiphene citrate (CC) 3
- Laparoscopic ovarian drilling as an alternative to gonadotrophins in patients who need laparoscopy for another reason 3
- In vitro fertilization (IVF) as a high-risk option for ovarian hyperstimulation syndrome, but with a higher live birth rate compared to controls 4
Preconception and Prenatal Care
Women with PCOS and amenorrhea should receive preconception and prenatal care to reduce pregnancy complications, including: